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At least 1,207 records · Page 67Linked to original sources
PubMed1995

Outpatient management of acute urticaria: the role of prednisone.

STUDY OBJECTIVE: To evaluate the efficacy of a 4-day "burst" course of prednisone added to standard treatment with H1 antihistamines for the management of acute urticaria in outpatients. DESIGN: Prospective, randomized, double-blinded, clinical trial. SETTING: Emergency department of an urban tertiary care teaching hospital. PARTICIPANTS: Adult patients with urticarial rash of no more than 24 hours' duration, regardless of cause. Patients were excluded if they manifested wheezing, stridor, or angioedema or if they had taken antihistamines or glucocorticoids within 5 days of arrival at the ED. Patients also were excluded if there was a history of diabetes or active peptic ulcer disease. INTERVENTIONS: All patients were asked to evaluate the severity of pruritus ("itch score") on a 10-cm visual analog scale. Patients were then given diphenhydramine, 50 mg intramuscularly, and discharged home on a regimen of hydroxyzine, 25 mg orally, every 4 to 8 hours for pruritus, plus either prednisone, 20 mg, or placebo orally every 12 hours for 4 days. Patients' conditions were reassessed clinically, with itch score calculated again 2 days later, and again at 5 days by telephone. RESULTS: Forty-three patients were enrolled; 24 received prednisone and 19 received placebo. The two groups had similar itch scores at enrollment (prednisone, 8.1 +/- 1.7; placebo, 7.4 +/- 2.1, P = .25 [ANOVA]), but at 2- and 5-day follow-up the prednisone group had significantly lower itch scores (1.3 +/- 1.3 and .0 +/- .0 versus 4.4 +/- 2.2 and 1.6 +/- 1.0, respectively; P < .0001 [ANCOVA] at each interval) and greater clinical improvement in rash. Response did not correlate with age, sex, or identification of an allergen. No adverse effects were noted in either group. CONCLUSION: The addition of a prednisone burst improves the symptomatic and clinical response of acute urticaria to antihistamines. Patients' conditions improved more quickly and more completely when prednisone was administered, without any apparent adverse effects.

Acute Disease↗
PubMed1995

Safety and efficacy of nebulized racemic epinephrine in conjunction with oral dexamethasone and mist in the outpatient treatment of croup.

STUDY OBJECTIVE: To identify patients with croup who after treatment with nebulized racemic epinephrine, oral dexamethasone, and mist may be safely discharged home after a period of observation. DESIGN: Prospective interventional. SETTING: Urban children's hospital emergency department. PARTICIPANTS: Children with croup who received racemic epinephrine for the treatment of stridor at rest. INTERVENTIONS: After treatment with .5 mL racemic epinephrine, .6 mg/kg dexamethasone PO, and mist, patients who were assessed as being safe for discharge after 3 hours of observation were discharged home and contacted for 48-hour follow-up. RESULTS: Fifty-five patients with croup were treated with racemic epinephrine. Thirty patients (55%) had sustained responses and were discharged home after 3 hours of observation. No recurrence of respiratory distress and no return visits for medical care were reported (95% confidence interval, 0% to 8.0%). CONCLUSION: Patients with croup who are treated with racemic epinephrine, oral dexamethasone, and mist may be safely discharged home if the patient is assessed as ready for discharge after 3 hours of observation.

Administration, Inhalation↗
PubMedDate not supplied

Porcine model of airway mucosal injury.

PURPOSE: The development of a reliable animal model of laryngeal or tracheal stenosis has been limited by lack of reproducibility, high morbidity and mortality, and cumbersome technique. The small size of previously proposed models has limited the development of innovative reconstructive techniques. MATERIALS AND METHODS: Eleven of 15 post-weanling commercial piglets underwent injury by a sharpened metal rod to the anterior half of the subglottic region at repeated intervals under endoscopic guidance. Four of 15 animals did not undergo injury and served as control for normal subglottic growth over time. Each airway was sized by endotracheal tube (ETT) passage and endoscopic photography over time, and the degree of total stenosis was estimated in comparison to the control animals. RESULTS: The first two animals underwent daily injury and expired from copious granulation tissue. Eight additional animals developed symptomatic subglottic stenosis manifested by audible stridor and intercostal retractions while undergoing injury every third day. Photographs documented the size of the stenosis to be greater than 50% (40% by ETT sizing) with a mean of three injuries in a mean time of 18 days. CONCLUSION: The porcine model shows a high degree of tolerance with minimal morbidity and consistent reliable results in an animal model of airway stenosis that is suitable for further innovative studies.

Animals↗
PubMedDate not supplied

Acute supraglottitis in adults: early indicators of airway obstruction.

PURPOSE: To show that cardinal signs of upper airway obstruction are characteristically absent in the early phases of potentially fatal supraglottitis. PATIENTS AND METHODS: The hospital records of 9 previously healthy adults who died from autopsy-proven supraglottitis within 12 hours after sudden onset of severe sore throat. RESULTS: Six patients who were discharged from the emergency room with a diagnosis of pharyngitis died at home within 4 hours after dismissal. Three patients suspected of supraglottitis were admitted and treated medically; by the time signs of respiratory obstruction appeared, attempts at airway intervention failed. None of the 9 patients presented with symptoms or signs of respiratory distress, but all gave a history of fulminant sore throat associated with chills and fever. In all patients, the pulse rate was above 100 per minute. CONCLUSION: In the early phases of acute supraglottitis, the most reliable indicator of impending airway obstruction is a rapidly developing severe sore throat. Dyspnea, tachypnea, retractions, stridor, and cyanosis are manifestations of advanced stages of the infection and should not be awaited to determine the need for airway intervention.

Adult↗
PubMed1983

Nonorganic upper airway obstruction.

Two cases of severe dyspnea and stridor with upper airway obstruction of obscure origin are discussed. Complete medical evaluation could identify no organic cause for the symptoms, and functional upper airway obstruction was diagnosed. Treatment with psychotherapy and relaxation techniques was successful. Diagnosis can be made with pulmonary function studies. Flow-volume loops may show a lower inspiratory vital capacity than expiratory vital capacity and a discrepancy between inspiratory flow limitation and airway resistance. It is important to establish a functional etiology to prevent unnecessary treatment and provide proper care.

Adolescent↗
PubMed1993

The double-reversing Z-plasty in primary palatoplasty: operative experience and early results.

The double-reversing Z-plasty of Furlow for closure of the soft palate was used in 34 children with various types of cleft palate. Mean age at repair was 12.8 months. Intraoperative experience was favorable, with acceptable operating time and blood loss. Length of hospitalization averaged 1.9 days. Postoperatively, two children experienced temporary stridor, which resolved within 24 to 48 hours. One child had dehiscence of the hard palate (Von Lagenbeck repair) 4 weeks postoperatively, and three children developed small oronasal fistulae. Early speech evaluation demonstrated adequate soft palate mobility in 33 of 34 patients, with observable velopharyngeal function. Twelve children had mild velar compromise, with eight exhibiting slight nasal air escape.

Child, Preschool↗
PubMed2003

Selenium in the treatment of radiation-associated secondary lymphedema.

PURPOSE: The aim of this explorative study was to evaluate the impact of selenium in the treatment of lymphedema after radiotherapy. MATERIALS AND METHODS: Between June 1996 and June 2001, 12 patients with edema of the arm and 36 patients with edema of the head-and-neck region were treated with selenium for therapy-related lymphedema. Of these 36 patients, 20 had interstitial endolaryngeal edema associated with stridor and dyspnea. All patients received sodium selenite over 4 to 6 weeks. RESULTS: Self-assessment using a visual analog scale (n = 48) showed a reduction of 4.3 points when comparing pre- and posttreatment values (p < 0.05). Of 20 patients with endolaryngeal edema, 13 underwent no tracheostomy, 5 underwent a temporary tracheostomy, and only 2 underwent a permanent tracheostomy. Ten of 12 patients with arm edema showed a circumference reduction of the edematous limb and improvement in the Skin-Fold Index by 23.3 points. An improvement of one stage or more was shown by the Földi or the Miller score (n = 28) in 22 (Földi score) and in 24 (Miller score) patients. CONCLUSIONS: Treatment with sodium selenite is well tolerated and easy to deliver. Additionally, our results suggest that sodium selenite has a positive effect on secondary-developing lymphedema caused by radiation therapy alone or by irradiation after surgery.

Adult↗
PubMed1991

Subglottic plasma cell granuloma: report of a case.

A case of subglottic and tracheal plasma cell granuloma masquerading as tumor invasion by thyroid malignancy was successfully treated using CO2 laser. A 55-year-old woman with a history of inspiratory stridor of almost 10 months duration was admitted to our clinic, and examinations revealed a mass in the subglottic space and trachea obstructing the airway. CT scan findings was suggestive of tumor invasion from a thyroid gland malignancy, however, histopathological examination of a biopsy specimen showed it to be plasma cell granuloma. Cases of plasma cell granuloma of the larynx and trachea are reviewed and discussed.

Female↗
PubMed1980

A case of subglottic hemangioma: a new technique of surgical removal.

Congenital malformation of the larynx are life-threatening anomaly for newborns and infants. Although tumorous lesions in these malformations (especially subglottic hemangioma) are extremely rare, when they do occur some definitive attempts should be made to treat them in infancy. This report concerns a case of subglottic hemangioma with marked stridor and sternal retractions which had begun in the third month of age in a six month-old male. In the excision of the hemangioma a new technique is employed. That is: the excision through the laryngofissure was made under surgical microscope. Assuming that careful removal of the subepithelial hemangioma and closure of the overylaying epithelia would help to maintain the mucosa and thereby avoid excessive scarring, the hemangiomatous tissue was completely removed while preserving the overlaying epithelial layer.

Glottis↗
PubMed2004

Laryngeal dystonia in a case of severe motor and intellectual disabilities due to Japanese encephalitis sequelae.

Laryngeal dystonia is characterized by stridor due to vocal cord dystonia and is observed in extrapyramidal disorders. Recently, botulinum toxin injection has been used as a primary therapy. Generally, severe motor and intellectual disabilities (SMID) are frequently complicated by various types of respiratory disorders. We report a SMID case with Japanese encephalitis sequelae showing repeated vocal cord abductor disturbance due to laryngeal dystonia, in addition to generalized dystonia, in whom MRI revealed basal ganglia lesions. Tracheostomy was effective for the case, and we believe that botulinum toxin injection may be inappropriate in SMID, both ethically and technically. Also, laryngeal dystonia should be considered as a cause of respiratory disorders in SMID.

Basal Ganglia↗
PubMed1998

The cost-effective use of nebulized racemic epinephrine in the treatment of croup.

Recent studies have shown that discharging to home an emergency department (ED) patient with croup if the patient is clinically stable 3 to 4 hours after being treated with nebulized racemic epinephrine (NRE) is safe and cost-effective. The objective of this study was to determine if EDs in our geographic area are using NRE cost-effectively in the management of croup. A survey was mailed to the ED medical directors of 23 hospitals in Ohio, Kentucky, and Indiana within a 150-mile radius of our teaching/referral children's hospital. All the hospitals surveyed were community hospitals with EDs and in-patient pediatric units. The survey presented a 2-year-old with a croup-like illness and stridor at rest whom they have just treated with NRE and dexamethasone. The medical directors were asked what their disposition would be once the NRE therapy has been completed: automatically admit, transfer, discharge immediately, or observe for 3 to 4 hours and if stable at that time discharge to home with follow-up. Seven (30%) indicated they would automatically admit, compared with 16 (70%) who indicated they would observe for 3 to 4 hours (P = .06). This article discusses potential reasons that 30% of the ED medical directors in our geographic area would automatically admit these patients rather than observe for signs of improvement that could lead to safe discharge and resultant cost savings.

Child, Preschool↗
PubMedDate not supplied

The disposition of children with croup treated with racemic epinephrine and dexamethasone in the emergency department.

This prospective cohort study evaluated the effectiveness and safety of a selective discharge policy for patients treated with racemic epinephrine (RE) and intramuscular (IM) dexamethasone (DEX) in the emergency department (ED). Children younger than 13 years of age presenting to the ED with croup who were treated with RE and IM DEX and discharged home were enrolled in the study. Patients were discharged home if they were free of intercostal retractions and stridor at rest, following a 2 h observation period. Telephone follow up determined whether further medical attention for croup was required within 48 h of discharge from the ED. Eighty-two patients were enrolled in the study over a one year period. Six of these patients (7%) required follow up for croup within 48 h of discharge and 2 (2%) required admission. We conclude that a subset of patients with croup treated with RE and IM DEX in the ED can be safely discharged home.

Adrenergic Agonists↗
PubMedDate not supplied

Brillo pad crack screen aspiration and ingestion.

Crack cocaine is commonly smoked in a pipe with a metallic filter made from a steel wool scouring pad. We report an unusual complication of smoking crack cocaine: the aspiration and ingestion of a Brillo pad filter. A 34-year-old female presented 7 h after drinking beer and smoking crack. She was concerned that she might have inhaled the "screen" from her crack pipe, a piece of Brillo pad the size of her fingertip. She complained of "burning" in her throat, a foreign body sensation, and change in her voice, but no dyspnea, dysphagia, or abdominal pain. On physical examination, she was afebrile with a pulse of 105 beats/min and respiratory rate of 24 breaths/min. She was tearful and spoke in a whisper. There were no visible oropharyngeal burns and the lungs were clear to auscultation, but she had intermittent inspiratory stridor. The O2 saturation was 96%, and the ethanol concentration was 100 mg/dl. No foreign body or burn was seen on indirect laryngoscopy. A lateral neck x-ray study showed a normal epiglottis and no foreign body. Chest x-ray studies were unremarkable. Fiberoptic laryngoscopy showed left posterior arytenoid edema and swelling. An abdominal x-ray study revealed a foreign body in the right lower quadrant consistent with the Brillo pad filter. The next morning, the patient was asymptomatic and was discharged, recovering without sequellae. While crack pipe screen aspiration is a rarely reported event, physicians should be aware of the potential for foreign body aspiration and ingestion by this mechanism.

Adult↗
PubMed2005

[Treatment of a compressive bronchogenic cyst by computed tomography-guided needle aspiration].

INTRODUCTION: Bronchogenic cysts are benign tumours of the posterior or middle mediastinum. Treatment usually consists of complete surgical resection. We report the case of an elderly woman presenting with an inoperable bronchogenic cyst causing tracheal compression which was treated successfully using computed-tomography (CT)-guided needle aspiration. CASE REPORT: A 92 years old woman was admitted for inspiratory dyspnoea associated with stridor. She reported the incidental discovery of a right paratracheal mass, 2 years previously. Thoracic CT scan and bronchoscopy revealed a large mediastinal bronchogenic cyst causing tracheal compression. Surgery was contraindicated because of the patient's age and cardiac disease. CT-guided needle aspiration of 250 ml of viscous fluid was performed, followed by rapid clinical improvement. The patient remained symptom free for several months. The procedure was repeated successfully one year later because of a recurrence of compression. CONCLUSION: This observation supports the potential use of CT guided transthoracic needle aspiration as an alternative to surgical treatment in cases of inoperable symptomatic bronchogenic cyst.

Aged, 80 and over↗
PubMed1997

Fewer interventions in the immediate post-extubation management of pediatric intensive care unit patients: safety and cost containment.

PURPOSE: The purpose of this article was to compare the safety and patient charges of two postextubation treatment regimens. MATERIALS AND METHODS: Twenty-two pediatric patients, between the ages of 7 months and 13 years, who were mechanically ventilated for less than 5 days were studied in a prospective randomized nonblinded study at a multidisciplinary pediatric intensive care unit. Immediately after extubation all patients received supplemental oxygen, administered via mask or nasal cannulae, at a flow rate or concentration sufficient to maintain the pulse oximetric arterial oxygen saturations > 95%; arterial blood gas analyses were performed at 30 minutes after extubation. The subjects were randomly assigned to one of two protocols. Protocol A (our standard management) consisted of (1) three nebulized albuterol treatments administered 1 hour apart, and (2) a chest radiograph obtained within 60 minutes of extubation. Protocol B included one nebulized albuterol treatment administered immediately after extubation. We measured the heart rate, respiratory rate, and arterial blood pressure immediately after and at 60, 120, and 180 minutes following extubation. The following data were also recorded: arterial blood gas analysis results and continuous pulse oximetric arterial oxygen saturation levels. Any significant complications, such as stridor, respiratory distress, or requirement for reintubation, were noted if they occurred within 24 hours of extubation. Patient charge costs were calculated after obtaining the prevailing hospital and physician charges at the time of the study. RESULTS: Eleven patients completed each arm of the study (total = 22). There were no statistically significant differences between the two groups with respect to arterial pH, serum bicarbonate, pulse oximetric arterial oxygen saturation, arterial blood pressure, respiratory rate, or heart rate (P > .05). Patients treated with Protocol A had a statistically, but not clinically, significant higher mean PaO2 and PaCO2 (P = .02 and P = .05, respectively) than those in Protocol B. Associated charges per patient for Protocol A were $863.50 versus $476.00 for Protocol B. This is a savings of $387.50 per patient. Our pediatric intensive care unit provides care to over 600 intubated patients per year, which would equate to a charge savings of $232,500.00 per year. CONCLUSION: A modified postextubation management protocol, consisting of fewer interventions, resulted in significant patient charge savings with no increased risk to the patient.

Administration, Inhalation↗
PubMed2002

When midazolam fails.

Significant distress is experienced by patients, families, and caregivers when a symptom or disorder, such as an agitated delirium, becomes an intractable, or a catastrophic event, such as irreversible stridor. When palliative sedation is indicated for these patients, midazolam is usually the preferred drug. In some cases, however, midazolam fails to provide adequate sedation. Two cases are presented to illustrate this phenomenon and explore the possible mechanisms underlying this lack of response. These mechanisms appear to be multifaceted. The heterogeneity of the GABA(A) receptor complex and the alterations that this complex can undergo functionally can explain, to some degree, the diversity of the physiological and pharmacological outcomes. Other factors responsible for the diversity in response may include concomitant medications, age, concurrent disease, overall health status, alcohol use, liver disease, renal disease, smoking and hormonal status. Evidence-based guidelines on alternative treatment options should midazolam fail are required. In the interim, a lower threshold for adding an alternative drug, such as phenobarbital, or substituting midazolam with another drug, such as propofol, should be considered in these circumstances.

Humans↗
PubMed2000

Anterior horn cell disease and olivopontocerebellar hypoplasia.

To date, fewer than 30 cases of anterior horn cell disease with associated olivopontocerebellar hypoplasia have been reported. We describe five patients and review the literature on this uncommon disorder. In addition to a syndrome of progressive spinal muscular atrophy similar to that seen in Werdnig-Hoffmann disease, this disorder is characterised by hypoplasia of the olivary nuclei, pons, and cerebellum. Additional clinical features may include dysmorphism, abnormal eye movements, stridor, congenital joint contractures, and enlarged kidneys. Pontocerebellar hypoplasia may be associated with posterior fossa cystic malformations, cerebral atrophy, and a demyelinating neuropathy.

Cerebellar Diseases↗
PubMed1999

Vocal cord paralysis and hypoventilation in a patient with suspected Leigh disease.

The authors report the case of a 16-month-old male with suspected Leigh disease, which was diagnosed on the basis of the clinical manifestations, abnormal lactate stimulation test, proton magnetic resonance spectroscopy, and neuroradiologic findings. Progressive stridor resulting from bilateral vocal cord paralysis and hypoventilation was evident. The authors suggest that for infants or children who exhibit vocal cord paralysis, mitochondrial disorders, such as Leigh disease, should be considered.

Humans↗